Healthcare Provider Details

I. General information

NPI: 1447329438
Provider Name (Legal Business Name): ALEXANDRA L HAAGENSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

7 HOLLY CIR
WESTON MA
02493-1421
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-3023
  • Fax: 617-730-0194
Mailing address:
  • Phone: 781-235-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204300
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number204300
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: